Nursing care plan development and implementation

Nursing Care Plan: Low Self-Esteem

Nursing Care Plan

low self-esteem

Client is 18 years of age and presents with vomiting, weight loss, diarrhea and persistent headache for last few weeks. Client reports she is presently taking a course on tourism in a private school and that her elder sister is pursuing a degree in medicine at an Ivy League college. Her younger brother attends a top-ranked high school and will graduate this year. The client's father is an attorney and her mother is a banker. The client's family lives in a posh mansion and employ a foreign domestic helper.

The client's history reveals that 'Jaslyn' has always been a quiet girl and doesn't have many friends. Jaslyn's parents are seldom at home and while they are very proud of the achievements of their eldest daughter and their youngest son Jaslyn failed to gain admission to college due to her poor achievement in high school. Jaslyn was therefore, enrolled in a private school by her parents. Since having left high school Jaslyn has pretty much become a loner and doesn't keep in contact with her friends from high school and in fact, Jaslyn sits on the corner of her bed and stares at the floor much of the time. Jaslyn feels ashamed that she is not smart like her siblings and knows her parents are highly disappointed in her. Jaslyn feels completely useless and doesn't know what to do. Jaslyn wishes for cancer so she can die.

III. PHYSICAL ASSESSMENT:

Height: 1.6m = 5.5 ft

Weight: 45kg = 99.21 lbs.

BP: 90/60

BMI

Respiration: 12 bpm

Pulse: 60 bpm

IV. GOAL

Develop a nursing care plan for this client through use of the nursing process while demonstrating critical thinking skills in formulating the best plan of care for this individual client.

V. BRIEF REVIEW of LITERATURE

The work of Edward P. Lemay and Richard D. Ashmore entitled: "The Relationship of Social Approval Contingency to Trait Self-Esteem: Cause, Consequence, or Moderator?" relates a longitudinal study which examined three theoretical models of the relationship between contingency of self-worth on social approval and trait self-esteem. Lemay and Ashmore state that "Properly speaking, a man has many social selves as there are individual show recognize him and carry an image of him in their mind. To wound any one of these his images is to wound him." James 1890/1950; p.294; as cited in Lemay and Ashmore, 2006; p. 122) in the view of James there are implications of a profound nature in understanding self-esteem especially as regarding the social self and further that "perceived acceptance from others is a determinant of, if not interchangeable with feelings of self-worth." (Lemay and Ashmore, 2005; Murray Rose, Bellavia, Holmes & Kusche, 2002) in another study conducted and reported in the work of Leary et al. (2003) are beliefs that "self-esteem is not contingent on social approval are inaccurate." (2006) it is related in the work of Sprinkle (2006) entitled: "Young, Attractive, Athletic, Popular, Smart and Depressed" that a senior at Scarsdale High who is referred as 'Nicole W.' who was starting to feel the pressures of going to college. It wasn't the college-application process that bothered her, but rather the thought of leaving her secure environment and being out on her own. A big-boned girl who always struggled with her weight, her depression manifested with a drastic exercise regimen and a loss of appetite. Her mother, who she's especially close to, thought seeing her daughter take an interest in her weight was a good thing, and didn't notice any sort of problem. That is, until the dentist mentioned his concerns about Nicole being bulimic. It turns out she had a lot of anxiety and fear about separating from her parents and going to college, and this is how it manifested. Depression was the root of the bulimia, according to Dr. Belkin, who eventually treated her with a combination of therapy and medication."

The work of Gloria J. Evans, entitled: "The Relationship of Attachment and Shame to Anorexia: A Case Study Comparing Restrictive and Normal Eaters" relates that research has provided description of and as well "many clinicians have reported the anorexic patient as socially disconnected, having a disembodied sense of self, perfectionist expectations and inadequate and shameful feelings." The work entitled: "Adolescent Depression" published in the Nevada Kidscount journal Issue One in Winter (2005) relates that each year approximately 50 out of every one-thousand teenagers experience "the torment of major depression. Clinical depression involves overwhelming feelings of being sad for weeks or longer." (Adolescent Depression, Winter 2006) it is stated by the Center for Mental Health Services that 12.5% of teenagers "endure clinical depression." (Evans, 2005) Mood disorders are many times diagnosed among teens as: (1) major depressive disorder; (2) dysthymic disorder; and (3) bipolar disorder. (Evans, 2005)

It is related in a separate case study reported by Zuckerbrot, et al. (2007) in the work entitled: "Guidelines for Adolescent Depression in Primary Care (GLAD-PC): I. Identification, Assessment and Initial Management. Vol. 120, No. 1.Nov 5, 2007 Pediatrics Journal. report that evidence indicates that only a mere fraction of depressed adolescents are identified in clinical settings and approximately one-half of depressed adolescents are diagnosed prior to adulthood. In order to identify those youths who are at high risk, tools are used such as standardized written instruments. Additionally stated is as follows: "The involvement of the family is critical in all phases of management and should be included in the assessment for depressive disorders. Family relationships also may affect the presentation of depression in adolescents." Additionally considered should be other factors such as: (1) family cultural background; (2) substance abuse; (3) anxiety disorder; (4) attention deficit hyperactivity disorder; (5) physical abuse; (6) sexual abuse; and (7) trauma. (Zuckerbrot, et al., 2007) Zuckerbrot et all states that it is critical to "establish relevant links/collaboration with mental health resources in the community which may include patients and families who have dealt with adolescent depression and are willing to serve as resource to other affected adolescents and their family members.

Preparation for Managing Depression in Primary Care

Source: American Academy of Pediatrics (2007)

VI. ASSESSMENT of CLIENT